PMT17-03980 City of Menifee Permit No.: PMT17-03980
29714 HAUN RD. T Residential Alteration
`KCCEL/� MENIFEE,CA 92586 Type:
MENIFEE Date Issued:
1110612017
PERMIT
Site Address: 31494 CAPRICE RD, MENIFEE, CA 92584 Parcel Number: 360-612-009
Construction Cost: $1,000.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of UNDERGROUND GAS AND ELECTRIC FOR FUTURE USE. -
Work:
Owner Contractor
JARVIS CULP
31494 CAPRICE RD
MENIFEE,CA 92584
Applicant License Number.
MENIFEE, CA
Fee Description OQt Amount!$)
Services, Switchboards, Control Centers&Panels 1 116.00
Receptacle, Switch, Outlet&Fixture 1 116.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Plumbing 1 0.00
General Plan Maintenance Fee-Electrical 1 11.60
$271.60
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and
specifications or from preventing builiding operations being carried on thereunder when in violation of the Building Code or of any other
ordinance of City of Menifee.Except as otherwise stated,a permit for construction under which no work is commenced within six
months after issuance,or where the work commenced is suspended or abandoned for six months,shall expire,and fees paid shall be
forfeited.
AA_Bidg_Permd_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
I hereby affirm under penalty of perjury that 1 am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and �I am exempt from licansure under the Contractors State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class License No. By my signature below I acknowledge that,except for my personal residence
Expires Signature in which I must have resided for at least one year prior to completion of
WORKER'S COMPENSATION DECLARATION improvements covered by this permit.I cannot legally sell a structure that I
have built as an owner-builder if it has not been constructed in its entirety by
o I hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that a copy of the applicable law,Section
have and will maintain a certificate of consent of self-insure for workers 7044 of the Business and Professions Cade,is available upon request when
compensation,issued by the Director of Industrial Relations as provided for this application is submitted or at the following website:
by Section 3700 of the Labor Code,for the performance of work for which www.le I ! .html.
this permit is Issued.
Policy# ,,FF�� �.../F �/� Date
❑I have and will main[ or(�$61pengUon insurance,as required by P O OWNER AUTHORIZED AGENT
section 3700 of the Lab A rmance of the work for which o By my signature below I certify to each of the following:I am the property
this permit is issued.My euu�iSLs mpensat!on insurance carrier and policy owner or authorized to act on the property owners behalf.I have read this
number are: -7 application and the Information I have provided is correct.I agree to comply
Carrier Nov D 6 ZD i L with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# Expires enter the abov tified.pQEerty for inspection puryoses.
(This section need n= � � e I is for one-hundred Date
dollars($100)or le �g PROPE WNER ORKUTHORIZED AGENT
o I certify that in the performance of the work for which this permit is issued,
Ishallnotemolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
Code,I shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date mixture containing a hazardous material equal to or greater that the
amounts specified an the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS in Yes !6 No
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use ofthe building by the applicant or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY oyes IFNo
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 1000 feet of the
lending agency for the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) 0 Yes P40
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of
Contractors License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous 75 o in
and Professions Code).Any city or county that requires a permit to OYes o / Date It & �I
y
construct,alter,improve,demolish or repair any structure,prior to its pR EO!'� NER OR AU RAZED AGENT
Issuance,also requires the applicant for the permit to file a signed statement
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING(RRP)
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
Business and Professions Code)or that he or she is exempt from Iicensure receiving compensation for most work that disturbs paint in a pre-1978
and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-certified firms and comply with
an Applicant for a permit subjects the applicant to a civil penalty of not more required practices.This Includes rental property owners and property
than($500), managers who do the paint-disturbing work themselves or through their
o I,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.eoa.eov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-80D-424-LEAD(5323).
Code,The Contractors State License Law does not apply to an owner of a ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or Improved for the purpose of sale. o No EPA Lead-Safe Certified Firm is required for this project because:
o 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 70",Business and Professions
Code:The Contractors State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
',Menifee
DATE: t '- (p ' 7 PERMIT/PLAN CHECK NUMBER I 1 - I
TYPE: O COMMERCIAL PRESIDENTIAL 0 MULTI-FAMILY 0 MOBILE HOME O POOL/SPA ON SIGN
SUBTYPE: O ADDITION 0 ALTERATION O DEMOLITION ,'9'ELECTRICAL O MECHANICAL
O NEW 4wPLUMBING O RE-ROOF NUMBER OF SQUARES
b
DESCRIPTION OF WORK
l
PROJECTADDRESS �L( /�� Lfi,ni (�L Ce a ''1JlPv.:tzz C.. Fi ZIP
ASSESSOR'S PARCEL NUMBER J�QO 'TC� Q-),CCPI LOT SRO TRACT 30e
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OWNER NAME J f `n
ADDRESS 3I�IQ (`;C� U�p ikerN e Yt Z'
PHONE qG ( 4-W0 gaa3 EMAIL cd,� 't G QtocL1,( .Ca
APPLICANT NAME 'Qj-'(it S 1Z (J„( tt ,^
%
ADDRESS (� ��Ct� r C2 O-.7 4 .Q Z 04 S_LT(,
11
PHONE (G ��6 q,Z � EMAIL C_Q.kpcQGIuKe.
CONTRACTOR'S NAME OWNER BUILDER? ES ONO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION $ t 600 . J SO FT L SO FT
APPLICANT'S SIGNATURE �- DATE (0 ';L4--k -7
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OFME IF E BUSINESS LICENSE NUMBER
9UILDING PLANNING NGINEERING FIRE
PERMIT FEE �)-� .� SMIP GREEN
PLAN CHECK FEE I INVOICE TOTAL
OWNER BUILDER VERIFIED OYES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES O NO
City of Menifee Building&5afety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
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Property Owners Name 7u-,r V s l Ltd .(,o
Property Address cJ ( L-i c a � t';C e